Provider Demographics
NPI:1184232456
Name:REYES, GRACE ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:REYES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 ALCAZAR PL APT 107
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2879
Mailing Address - Country:US
Mailing Address - Phone:321-626-8654
Mailing Address - Fax:
Practice Address - Street 1:345 JUPITER LAKES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7100
Practice Address - Country:US
Practice Address - Phone:561-529-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist